Hanyang Med Rev.  2017 May;37(1):40-46. 10.7599/hmr.2017.37.1.40.

Recent trend of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) management

• Lee SW

• KMID: 2384007
• DOI: http://doi.org/10.7599/hmr.2017.37.1.40

Abstract

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common condition. However, many of the traditional therapies like monotherapy used in clinical practice fail to show efficacy. There is no one particular treatment to be recommended as monotherapy for CP/CPPS. The new concept of treatment which is "˜UPOINT' is introduced. The major barrier in treating men with CP/CPPS is the heterogenous nature of this syndrome. In order to treat appropriately, the patient should be evaluated individually to assess the nature of symptoms. To evaluate patients with chronic urologic pelvic pain, a six-point clinical phenotyping system has been developed. The clinical domains are urinary symptoms, psychosocial dysfunction, organ specific findings, infection, neurologic/systemic, and tenderness of muscles, which produces the acronym "˜UPOINT'. This clinical phenotyping system may provide a useful and clinically relevant framework for multimodal therapy for the treatment of CP/CPPS. However, the concept of UPOINT needs randomization, placebo or sham control studies to show verified treatment.

Keyword

Prostatitis; Pelvic Pain

MeSH Terms

Humans
Male
Muscles
Pelvic Pain*
Prostatitis
Random Allocation

Figure

• 

  Fig. 1 peration room setup for endoscopic ear surgeryMultifactorial etiology of chronic prostatitis/chronic pelvic pain syndrome

Reference

1. Krieger JN, Lee SW, Jeon J, Cheah PY, Liong ML, Riley DE. Epidemiology of prostatitis. Int J Antimicrob Agents. 2008; 31:Suppl 1. S85–S90.

2. Merskey H, Bogduk N. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Second Edition (Revised). International Association for the Study of Pain Press;2012. Available: http://www.iasp-pain.org/FreeBooks?navItemNumber=677.

3. Litwin MS, McNaughton-Collins M, Fowler FJ Jr, Nickel JC, Calhoun EA, Pontari MA, et al. The National Institutes of Health chronic prostatitis symptom index: development and validation of a new outcome measure. Chronic Prostatitis Collaborative Research Network. J Urol. 1999. 162:p. 369–375.

4. Nickel JC, Downey J, Hunter D, Clark J. Prevalence of prostatitis-like symptoms in a population based study using the National Institutes of Health chronic prostatitis symptom index. J Urol. 2001; 165:842–845.

5. Nickel JC. Prostatitis: lessons from the 20th century. BJU Int. 2000; 85:179–184.

6. Schaeffer AJ. Chronic prostatiitis and chronic pelvic pain syndrome. N Engl J Med. 2008; 355:1690–1698.

7. Shoskes DA, Nickel JC, Rackley RR, Pontari MA. Clinical phenotyping in chronic prostatitis/chronic pelvic pain syndrome and interstitial cystitis: a management strategy for urologic chronic pelvic pain syndromes. Prostate Cancer Prostatic Dis. 2009; 12:177–183.

8. Samplaski MK, Li J, Shoskes DA. Clustering of UPOINT domains and subdomains in men with chronic prostatitis/chronic pelvic pain syndrome and contribution to symptom severity. J Urol. 2012; 188:1788–1793.

9. He L, Wang Y, Long Z, Jiang C. Clinical significance of IL-2, IL-10, and TNF-alpha in prostatic secretion of patients with chronic prostatitis. Urology. 2010; 75:654–657.

10. Persson BE, Ronquist G. Evidence for a mechanistic association between nonbacterial prostatitis and levels of urate and creatinine in expressed prostatic secretion. J Urol. 1996; 155:958.

11. Westesson KE, Shoskes DA. Chronic prostatitis/chronic pelvic pain syndrome and pelvic floor spasm: can we diagnose and treat? Curr Urol Rep. 2010; 11:261–264.

12. Pontari MA, McNaughton-Collins M, O'leary MP, Calhoun EA, Jang T, Kusek JW, et al. A case-control study of risk factors in men with chronic pelvic pain syndrome. BJU Int. 2005; 96:559–565.

13. Tripp DA, Nickel JC, Wang Y, Litwin MS, McNaughton-Collins M, Landis JR, et al. Catastrophizing and pain-contingent rest predict patient adjustment in men with chronic prostatitis/chronic pelvic pain syndrome. J Pain. 2006; 7:697–708.

14. Nickel JC, O'Leary MP, Lepor H, Caramelli KE, Thomas H, Hill LA, Hoel GE. Silodosin for Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome; Result of a Phase II Multicenter, Double-Blind, Placebo Controlled Study. J Urol. 2011; 186:125–131.

15. Cheah PY, Liong ML, Yuen KH, Teh CL, Khor T, Yang JR, et al. Terazosin therapy for chronic prostatitis/chronic pelvic pain syndrome: a randomized, placebo controlled trial. J Urol. 2003; 169:592–596.

16. Nickel JC, Elhilali M, Emberton M, Vallancien G. The beneficial effect of alfuzosin 10 mg once daily in ‘real-life’ practice on lower urinary tract symptoms (LUTS), quality of life and sexual dysfunction in men with LUTS and painful ejaculation. BJU Int. 2006; 97:1242–1249.

17. Nickel JC, Krieger JN, McNaughton-Collins M, Anderson RU, Pontari M, Shoskes DA, et al. Alfuzosin and symptoms of chronic prostatitis-chronic pelvic pain syndrome. N Engl J Med. 2008; 359:2663–2667.

18. Shoskes DA. Use of antibiotics in chronic prostatitis syndromes. Can J Urol. 2001; 8:Suppl 1. 24–28.

19. Zhou Z, Hong L, Shen X, Rao X, Jin X, Lu Get, et al. Detection of nanobacteria infection in type III prostatitis. Urology. 2008; 71:1091–1095.

20. Nickel JC, Downey J, Clark J, Casey RW, Pommerville PJ, Barkin J, et al. Levofloxacin for chronic prostatitis/chronic pelvic pain syndrome in men: a randomized placebo-controlled multicenter trial. Urology. 2003; 62:614–617.

21. Anothaisintawee T, Attia J, Nickel JC, Thammakraisorn S, Numthavaj P, McEvoy M, et al. Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis. JAMA. 2011; 305:78–86.

22. Thakkinstian A, Attia J, Anothaisintawee T, Nickel JC. Alpha-blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). BJU Int. 2012; 110:1014–1022.

23. Tsivkovskii R, Sabet M, Tarazi Z, Griffith DC, Lomovskaya O, Dudley MN. Levofloxacin reduces inflammatory cytokine-levels in human bronchial epithelia cells: implications for aerosol MP-376 (levofloxacin solution for inhalation) treatment of chronic pulmonary infections. FEMS Immunol Med Microbiol. 2011; 61:141–146.

24. Nickel JC, Pontari M, Moon T, et al. A randomized, placebo controlled, multicenter study to evaluate the safety and efficacy of rofecoxib in the treatment of chronic nonbacterial prostatitis. J Urol. 2003; 169:1401–1405.

25. Nickel JC, Forrest JB, Tomera K, et al. Pentosan polysulfate sodium therapy for men with chronic pelvic pain syndrome: a multicenter, randomized, placebo controlled study. J Urol. 2005; 173:1252–1255.

26. Goldmeier D, Madden P, McKenna M, Tamm N. Treatment of category III A prostatitis with zafirlukast: a randomized controlled feasibility study. Int J STD AIDS. 2005; 16:196–200.

27. Bates SM, Hill VA, Anderson JB, Chapple CR, Spence R, Ryan C, et al. A prospective, randomized, double-blind trial to evaluate the role of a short reducing course of oral corticosteroid therapy in the treatment of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2007; 99:355–359.

28. Nickel C, Atkinson G, Krieger J, Mills J, Pontari M, Shoskes D, et al. Preliminary assessment of safety and efficacy in a proof-of-concept, randomized clinical trial of tanezumab for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Urology. 2012; 80:1105–1110.

29. Shoskes DA, Zeitlin SI, Shahed A, Rajfer J. Quercetin in men with category III chronic prostatitis: a preliminary prospective, double-blind, placebo-controlled trial. Urology. 1999; 54:960–963.

30. Nickel JC, Downey J, Pontari MA, Shoskes DA, Zeitlin SI. A randomized placebo-controlled multicentre study to evaluate the safety and efficacy of finasteride for male chronic pelvic pain syndrome (category IIIA chronic nonbacterial prostatitis). BJU Int. 2004; 93(7):991–995.

31. FitzGerald MP, Anderson RU, Potts J, Payne CK, Peters KM, Clemens JQ, et al. Randomized multicenter feasibility trial of myofascial physical therapy for the treatment of urological chronic pelvic pain syndromes. J Urol. 2009; 182:570–580.

32. Thakkinstian A, Nickel JC. α-blockers, antibiotics and anti-inflammatories have a role in the management of chronic prostatitis/chronic pelvic pain syndrome. BJU Int. 2012; 110:1014–1022.

33. Nickel JC, Shoskes D. Phenotypic approach to the mamagemrent of chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. 2009; 10(4):307–312.

34. Tuğcu V, et al. A placebo-Controlled Comparision of the efficiency of Triple and Monotherapy in Category III B Chronic Pelvic Pain Syndrome (CPPS). Eur Urol. 2007; 51:1113–1117. discussion 1118.

35. Nickel JC, Shoskes D. Phenotypic approach to the mamagemrent of chronic prostatitis/chronic pelvic pain syndrome. Curr Urol Rep. 2009; 10:307–312.

36. Nickel JC, O'Leary MP, Lepor H, Caramelli KE, Thomas H, Hill LA, et al. Silodosin for men with chronic prostatitis/chronic pelvic pain syndrome: results of a phase II multicenter, double-blind, placebo controlled study. J Urol. 2011; 186:125–131.

37. Grimsley SJ, Khan MH, Jones GE. Mechanism of phosphodiesterase 5 inhibitor relief of prostatitis symptoms. Med Hypotheses. 2007; 69:25–26.

38. Chung SD, Huang CC, Lin HC. Chronic prostatitis and depressive disorder: a three year population-based study. J Affect Disord. 2011; 134:404–409.

39. Nickel JC, Mullins C, Tripp DA. Development of an evidence-based cognitive behavioral treatment program for men with chronic prostatitis/chronic pelvic pain syndrome. World J Urol. 2008; 26:167–172.

40. Gao M, Ding H, Zhong G, Lu J, Wang H, Li Q, Wang Z. The effects of transrectalradiofrequency hyperthermia on patients with chronic prostatitis and the changes of MDA, NO, SOD, and Zn levels in pretreatment and post-treatment. Urology. 2012; 79:391–396.

41. Anothaisintawee T, Attia J, Nickel JC, Thammakraisorn S, Numthavaj P, McEvoy M, et al. Management of chronic prostatitis/chronic pelvic pain syndrome: a systematic review and network meta-analysis. JAMA. 2011; 5(1):78–86.

42. Weinstock LB, Geng B, Brandes SB. Chronic prostatitis and small intestinal bacterial overgrowth: effect of rifaximin. Can J Urol. 2011; 18:5826–5830.

43. Pontari MA, Krieger JN, Litwin MS, White PC, Anderson RU, McNaughton-Collins M, et al. Pregabalin for the treatment of men with chronic prostatitis/chronic pelvic pain syndrome: a randomized controlled trial. Arch Intern Med. 2010; 170:1586–1530.

44. Nickel JC, Atkinson G, Krieger JN, Mills IW, Pontari M, Shoskes DA, et al. Preliminary assessment of safety and efficacy in proof-of-concept, randomized clinical trial of tanezumab for chronic prostatitis/chronic pelvic pain syndrome. Urology. 2012; 80:1105–1110.

45. Anderson RU, Wise D, Sawyer T, Chan C. Integration of myofascial triggerpoint release and paradoxical relaxation training treatment of chronic pelvicpain in men. J Urol. 2005; 174:155–160.

46. Magri V, Wagenlehner F, Perletti G, Schneider S, Marras E, Naber KG, et al. Use of the UPOINT chronic prostatitis/chronic pelvic pain syndrome classification in European patient cohorts: sexual function domain improves correlations. J Urol. 2010; 184:2339–2345.

47. Davis SN, Binik YM, Amsel R, Carrier S. Signs “UPOINT” to yes. J Urol. 2013; 189:146–151.

48. Shoskes DA, Nickel JC. Classification and treatment of men with chronic prostatitis/chronic pelvic pain syndrome using the UPOINT system. World J Urol. 31; 755–760.

49. Shoskes DA, Nickel JC. Phenotypically Directed Multimodal Therapy for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Prospective Study Using UPOINT. Urology. 2010; 75:1249–1253.

50. Shoskes DA, Nickel JC. Management of chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS): the studies, the evidence, and the impact. World J Urol. 2013; 31:747–753.